Understanding Pancreatic Cancer and its Treatment Options
Dr. Pugalenthi discusses Pancreatic Cancer and its treatment options.
Featured Speaker:
Learn more about Amudhan Pugalenthi, MD
Amudhan Pugalenthi, MD
Amudhan Pugalenthi, MD is a surgical oncologist with Dignity Health.Learn more about Amudhan Pugalenthi, MD
Transcription:
Understanding Pancreatic Cancer and its Treatment Options
Introduction: This is Hello Healthy, A Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Pancreatic cancer is the fourth leading cause of cancer related death in the United States. So how's it diagnosed? What are the treatment options? And are there ways to prevent it? Well, let's learn more about understanding pancreatic cancer with Dr. Amudhan Pugalenthi, Surgical Oncologist at Dignity Health. Dr. Pugalenthi, thank you so much for your time. First off, can you tell us a little bit about your background?
Dr. Pugalenthi: I'm a board certified surgeon and I did my board surgery residency at Bronx Lebanon Hospital in New York and I did my two years of Cancer research training at the Memorial Sloan Kettering Cancer Center. I did my further clinical fellowships in abdominal transplant surgery at the University of Minnesota and did a fellowship in surgical oncology at Mercy Medical Center Baltimore.
Host: Got you. Thank you so much for that. So turning to pancreatic cancer now, what is the incidence of pancreatic cancer? What are the demographics? Who generally gets this and how common is it?
Dr. Pugalenthi: Yeah. Pancreatic cancer is the fourth most common cancer causing death. It affects both the men and women equally and is slightly more common in African Americans. The peak incidence is about 60 to 70 years of age. Unfortunately it is estimated to be the number two cancer killer by 2030.
Host: Wow. So it's growing, holy cow. Okay. Well this is kind of alarming. So then what are the risk factors? What do we need to know?
Dr. Pugalenthi: So the risk factors include, smoking, morbid obesity, longstanding diabetes, chronic pancreatitis. Also metabolic syndrome is at risk, especially in men, including exposure to certain industry chemicals. And the 10% of the cancers are familial and runs in families. Some examples of genetic mutations which increases the risk are what we call the [inaudible 02:06] syndrome, which can increase the risk by one 30 fold. Other mutations include the BRCA mutation that causes breast cancer as well. And Lynch syndrome, to mention a few.
Host: All right, very good. So let's run those down again. Smoking, obesity, diabetes, and chronic pancreatitis are the risk factors. And then you also said there's a hereditary component as well that people should know about. So what are the different types of pancreatic cancer?
Dr. Pugalenthi: Yeah, well the most common type is what we call as the [inaudible 02:42] carcinoma, which arises from the duct of the exocrine pancreas. This is the part of the pancreas that secretes the digestive enzymes. Other types include neuroendocrine tumors that arise from the endocrines of the pancreas. This is the part of the pancreas that separates hormones, and other types include the SNR and other rare ones.
Host: So are there ways to prevent pancreatic cancer?
Dr. Pugalenthi: I had just mentioned earlier, we can lower the risk by avoiding the risk factors, but there are certain pre-malignant conditions that we should be aware like mucinous cysts, which are fluid filled SACS in the pancreas, and that can be removed by surgery before they turn into potential cancers.
Host: So let's talk more about these mucinous cysts. Can you explain more about these and how you identify them?
Dr. Pugalenthi: Yeah, majority of them are identified by imaging, like CT scan or MRI, which are done for evaluating abdominal pain or [inaudible] incidental finding. When we do the imaging for an unrelated condition. Furthermore, endoscopies and radiologists can risk stratify them to tell us which one of these to be removed surgically and which need to be closely monitored by CDL imaging. The IPMN and mucinous neoplasm are at increased risk of developing pancreatic cancer.
Host: So what you're saying is oftentimes with pancreatic cancer, you find this through a CT scan when you're actually looking for something else.
Dr. Pugalenthi: Not exactly pancreatic cancer. These mucinous cysts can be asymptomatic. They are pre-malignant conditions. They can be deducted as an incidental finding.
Host: Okay, so you see a mucinous cyst. Would that person have any signs or symptoms or even know that they had these cysts developing in their pancreas?
Dr. Pugalenthi: Yeah, sure, sure. But and the signs and symptoms depend on the location. If any mass or a tumor or even a cyst at the head of the pancreas, they can blog the bile ducts early and can cause jaundice. If they are arising in the body and tailor the pancreas, they can present with the abdominal pain or nonspecific symptoms like weight loss. A high degree of suspicion is needed among physicians, if an older patient presents with a new onset diabetes, the [inaudible 05:03] tumors on the other hand, secrete hormones and symptoms of those tumors mimic the action of the hormones they produce.
Host: Okay, got it. So then how do you diagnose pancreatic cancer? Obviously if you see a mucinous cyst, you're going to look at it further. But in other ways, how do you diagnose pancreatic cancer?
Dr. Pugalenthi: Usually the person has a cyst or mass on imaging as we talked about, and sometimes they present with the bile duct structure when they come present with jaundice. ERCP and endoscopy ultrasound done by gastroenterologist is very helpful with no masses seen either on a CT scan or an MRI.
Host: So then Dr. Pugalenthi, what are the available treatments for pancreatic cancer?
Dr. Pugalenthi: So if we identify them early, the best security option is performing surgery to remove the cancer along with the lymph nodes. Other options include chemotherapy and or, radiotherapy, but these tumors are led to be chemo and radio resistant. Immunotherapy is the latest treatment in the armamentarium of the medical oncologist to treat cancers like melanoma, lung cancer. But unfortunately, only 1% of pancreatic cancer, maybe candidates for immunotherapy. We do recommend genetic testing and counseling as part of the cancer treatment.
Host: So then what are the types of surgeries you perform for someone with pancreatic cancer?
Dr. Pugalenthi: Well, yes, Bill, we closely review the radiological images and design as a team. If a patient is completely resettable, if the cancer is in the head of the pancreas, the surgeon, the surgery is commonly referred to as a [inaudible 06:39] procedure. And if it is in the body the pancreas, we do what is called a distal pancreatectomy along with inlock removal of the spleen and lymph nodes.
Host: And then how about the options for people with advanced pancreatic cancer?
Dr. Pugalenthi: So, other than surgery, we have chemotherapy, radiotherapy, indwelling pain specialist, endoscopy and interventional radiology to alleviate the symptoms and the palliative care treatment for comfort care are available to help our patients.
Host: And then tell us about the treatment at Dignity health. What makes receiving treatment at Dignity health so different?
Dr. Pugalenthi: We have a multidisciplinary approach as a team, as recommended by the National Comprehensive Cancer Network or the NCCN, recommendation. So he's just closely in track with the radiologist, gastroenterologists, pathologist, and medical oncologist to decide the best treatment for an individual patient. Challenging cancer cases are reviewed with [inaudible] to get conferences during the Bi-weekly [inaudible] board meeting, at the Competency Blood Cancer Center to decide the best care in Con County.
Host: Well that's great to know. We have this type of care right in our backyard. And last question, Dr. Pugalenthi, what advice do you have for a pancreatic cancer patient coming from a pancreatic cancer surgeon?
Dr. Pugalenthi: Bill, for me, the most important person is the patient in front of me. It is a unique opportunity for me to change his or her life by making the right decisions, by maintaining a healthy diet, exercise, no smoking and annual health checks by the primary care physician will go a long way to prevent or detect cancers early.
Host: Well, Dr. Pugalenthi, this has really been informative. Thank you so much for your time.
Dr. Pugalenthi: Oh, thanks Bill. Thanks. It's my pleasure.
Host: That's Dr. Amudhan Pugalenthi. And for more information, please visit dignityhealth.org/bakersfield/cancercare. That's dignityhealth.org/bakersfield/cancercare. And if you like what you've heard, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, A Dignity Health Podcast. I'm Bill Klaproth, thanks for listening.
Understanding Pancreatic Cancer and its Treatment Options
Introduction: This is Hello Healthy, A Dignity Health Podcast. Here's Bill Klaproth.
Bill Klaproth: Pancreatic cancer is the fourth leading cause of cancer related death in the United States. So how's it diagnosed? What are the treatment options? And are there ways to prevent it? Well, let's learn more about understanding pancreatic cancer with Dr. Amudhan Pugalenthi, Surgical Oncologist at Dignity Health. Dr. Pugalenthi, thank you so much for your time. First off, can you tell us a little bit about your background?
Dr. Pugalenthi: I'm a board certified surgeon and I did my board surgery residency at Bronx Lebanon Hospital in New York and I did my two years of Cancer research training at the Memorial Sloan Kettering Cancer Center. I did my further clinical fellowships in abdominal transplant surgery at the University of Minnesota and did a fellowship in surgical oncology at Mercy Medical Center Baltimore.
Host: Got you. Thank you so much for that. So turning to pancreatic cancer now, what is the incidence of pancreatic cancer? What are the demographics? Who generally gets this and how common is it?
Dr. Pugalenthi: Yeah. Pancreatic cancer is the fourth most common cancer causing death. It affects both the men and women equally and is slightly more common in African Americans. The peak incidence is about 60 to 70 years of age. Unfortunately it is estimated to be the number two cancer killer by 2030.
Host: Wow. So it's growing, holy cow. Okay. Well this is kind of alarming. So then what are the risk factors? What do we need to know?
Dr. Pugalenthi: So the risk factors include, smoking, morbid obesity, longstanding diabetes, chronic pancreatitis. Also metabolic syndrome is at risk, especially in men, including exposure to certain industry chemicals. And the 10% of the cancers are familial and runs in families. Some examples of genetic mutations which increases the risk are what we call the [inaudible 02:06] syndrome, which can increase the risk by one 30 fold. Other mutations include the BRCA mutation that causes breast cancer as well. And Lynch syndrome, to mention a few.
Host: All right, very good. So let's run those down again. Smoking, obesity, diabetes, and chronic pancreatitis are the risk factors. And then you also said there's a hereditary component as well that people should know about. So what are the different types of pancreatic cancer?
Dr. Pugalenthi: Yeah, well the most common type is what we call as the [inaudible 02:42] carcinoma, which arises from the duct of the exocrine pancreas. This is the part of the pancreas that secretes the digestive enzymes. Other types include neuroendocrine tumors that arise from the endocrines of the pancreas. This is the part of the pancreas that separates hormones, and other types include the SNR and other rare ones.
Host: So are there ways to prevent pancreatic cancer?
Dr. Pugalenthi: I had just mentioned earlier, we can lower the risk by avoiding the risk factors, but there are certain pre-malignant conditions that we should be aware like mucinous cysts, which are fluid filled SACS in the pancreas, and that can be removed by surgery before they turn into potential cancers.
Host: So let's talk more about these mucinous cysts. Can you explain more about these and how you identify them?
Dr. Pugalenthi: Yeah, majority of them are identified by imaging, like CT scan or MRI, which are done for evaluating abdominal pain or [inaudible] incidental finding. When we do the imaging for an unrelated condition. Furthermore, endoscopies and radiologists can risk stratify them to tell us which one of these to be removed surgically and which need to be closely monitored by CDL imaging. The IPMN and mucinous neoplasm are at increased risk of developing pancreatic cancer.
Host: So what you're saying is oftentimes with pancreatic cancer, you find this through a CT scan when you're actually looking for something else.
Dr. Pugalenthi: Not exactly pancreatic cancer. These mucinous cysts can be asymptomatic. They are pre-malignant conditions. They can be deducted as an incidental finding.
Host: Okay, so you see a mucinous cyst. Would that person have any signs or symptoms or even know that they had these cysts developing in their pancreas?
Dr. Pugalenthi: Yeah, sure, sure. But and the signs and symptoms depend on the location. If any mass or a tumor or even a cyst at the head of the pancreas, they can blog the bile ducts early and can cause jaundice. If they are arising in the body and tailor the pancreas, they can present with the abdominal pain or nonspecific symptoms like weight loss. A high degree of suspicion is needed among physicians, if an older patient presents with a new onset diabetes, the [inaudible 05:03] tumors on the other hand, secrete hormones and symptoms of those tumors mimic the action of the hormones they produce.
Host: Okay, got it. So then how do you diagnose pancreatic cancer? Obviously if you see a mucinous cyst, you're going to look at it further. But in other ways, how do you diagnose pancreatic cancer?
Dr. Pugalenthi: Usually the person has a cyst or mass on imaging as we talked about, and sometimes they present with the bile duct structure when they come present with jaundice. ERCP and endoscopy ultrasound done by gastroenterologist is very helpful with no masses seen either on a CT scan or an MRI.
Host: So then Dr. Pugalenthi, what are the available treatments for pancreatic cancer?
Dr. Pugalenthi: So if we identify them early, the best security option is performing surgery to remove the cancer along with the lymph nodes. Other options include chemotherapy and or, radiotherapy, but these tumors are led to be chemo and radio resistant. Immunotherapy is the latest treatment in the armamentarium of the medical oncologist to treat cancers like melanoma, lung cancer. But unfortunately, only 1% of pancreatic cancer, maybe candidates for immunotherapy. We do recommend genetic testing and counseling as part of the cancer treatment.
Host: So then what are the types of surgeries you perform for someone with pancreatic cancer?
Dr. Pugalenthi: Well, yes, Bill, we closely review the radiological images and design as a team. If a patient is completely resettable, if the cancer is in the head of the pancreas, the surgeon, the surgery is commonly referred to as a [inaudible 06:39] procedure. And if it is in the body the pancreas, we do what is called a distal pancreatectomy along with inlock removal of the spleen and lymph nodes.
Host: And then how about the options for people with advanced pancreatic cancer?
Dr. Pugalenthi: So, other than surgery, we have chemotherapy, radiotherapy, indwelling pain specialist, endoscopy and interventional radiology to alleviate the symptoms and the palliative care treatment for comfort care are available to help our patients.
Host: And then tell us about the treatment at Dignity health. What makes receiving treatment at Dignity health so different?
Dr. Pugalenthi: We have a multidisciplinary approach as a team, as recommended by the National Comprehensive Cancer Network or the NCCN, recommendation. So he's just closely in track with the radiologist, gastroenterologists, pathologist, and medical oncologist to decide the best treatment for an individual patient. Challenging cancer cases are reviewed with [inaudible] to get conferences during the Bi-weekly [inaudible] board meeting, at the Competency Blood Cancer Center to decide the best care in Con County.
Host: Well that's great to know. We have this type of care right in our backyard. And last question, Dr. Pugalenthi, what advice do you have for a pancreatic cancer patient coming from a pancreatic cancer surgeon?
Dr. Pugalenthi: Bill, for me, the most important person is the patient in front of me. It is a unique opportunity for me to change his or her life by making the right decisions, by maintaining a healthy diet, exercise, no smoking and annual health checks by the primary care physician will go a long way to prevent or detect cancers early.
Host: Well, Dr. Pugalenthi, this has really been informative. Thank you so much for your time.
Dr. Pugalenthi: Oh, thanks Bill. Thanks. It's my pleasure.
Host: That's Dr. Amudhan Pugalenthi. And for more information, please visit dignityhealth.org/bakersfield/cancercare. That's dignityhealth.org/bakersfield/cancercare. And if you like what you've heard, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Hello Healthy, A Dignity Health Podcast. I'm Bill Klaproth, thanks for listening.